Comparative Analysis Of Clinical Efficacy Of Transcatheter Aortic Valve Replacement(TAVR) In The Treatment Of Aortic Stenosis And Aortic Regurgitation

Background:Common aortic valve diseases can be divided into aortic stenosis and aortic regurgitation,both of which can seriously affect patients’ quality of life and life span,and their disease progression is often irreversible.Common drug therapy can only alleviate patients’ symptoms and delay the course of disease,but cannot completely solve the disease.Surgical thoracotomy for aortic valve replacement or angioplasty has long been the only treatment for aortic valve disease,but studies have shown that about 60% of patients cannot tolerate thoracotomy due to advanced age,poor heart function,multiple complications or surgical contraindications.Since the application of transcatheter aortic valve replacement in2002,it has made rapid development and has become the first-line treatment for elderly high-risk patients with aortic stenosis.However,the initial domestic and foreign guidelines for the treatment of valvular disease only regarded it as an effective treatment for patients with aortic stenosis,and aortic regurgitation was considered as a contraindication for the operation due to its pathophysiological changes.With the gradual deepening of the research on TAVR surgery,the surgical indications of patients with aortic stenosis have been expanded to a medium-low risk degree,while for elderly patients with severe aortic regurgitation who are at high risk of surgery,the guidelines still do not clearly recommend the use of TAVR treatment.It was only mentioned in the expert consensus in 2021 that patients with simple aortic regurgitation can be treated with J-Valve valve through apical approach for TAVR treatment,which is still in the early stage of exploration and requires careful selection.Objective:By comparing the clinical efficacy of transcatheter aortic valve replacement in the treatment of aortic stenosis and aortic regurgitation in the Affiliated Hospital of Qingdao University in recent years,the effect of TAVR surgery in the treatment of aortic regurgitation was compared and analyzed,and the effectiveness of TAVR in the treatment of aortic regurgitation and the possibility of promotion were explored.Methods:A retrospective analysis was performed on 153 patients admitted to the Department of Cardiovascular Surgery for aortic valve disease in the Affiliated Hospital of Qingdao University from September 2017 to July 2022 prepared for transcatheter aortic valve replacement(TAVR),and all clinical data meeting the inclusion criteria,including medical history and demography,laboratory test data before and after surgery,and imaging auxiliary examination,were collected.Statistical methods such as independent or paired sample t-test,Chi-square test or Fisher’s exact probability test and Wilcoxon rank sum test were used to analyze the surgical process,complications and echocardiographic results before and after surgery.Results:A total of 149 patients were enrolled,with an average age of(73.89±6.27)years,including 96 males and 53 females.Death within 1 month after surgery,cerebral infarction,thoracotomy,CRP,extracorporeal circulation assistance,ECMO assistance,peripheral vascular complications,and application of the valve in-valve had no significant difference between the two groups.The incidence of permanent pacemaker implantation was higher in the aortic regurgitation group than in the stenosis group(27.03% vs 8.93%,P=0.012),and the incidence of perisvalular leakage was lower in the group with aortic regurgitation than in the stenosis group(27.03% vs 50.00%,P =0.015).The left ventricular ejection fraction of patients in the aortic stenosis group was improved 1 month after surgery compared with that before surgery [59.0(55,60)vs 56.0(45,60)P <0.001],and the left ventricular ejection fraction of patients in the aortic regurgitation group was not significantly changed 1 month after surgery compared with that before surgery(P =0.135).In the aortic stenosis group,the left ventricular end-diastolic diameter decreased 1 month after surgery compared with that before surgery [4.60(4.3,5.1)vs 4.85(4.4,5.5)P <0.001].The left ventricular end-diastolic diameter of aortic valve regurgitation group decreased 1month after surgery compared with that before surgery [5.2(4.6,5.5)vs 5.5(5.4,6.1)P <0.001].Conclusions: By comparing the clinical efficacy of patients undergoing transcatheter aortic valve replacement in the treatment of aortic stenosis and aortic insufficiency in cardiovascular surgery department of our hospital in recent years,this study compared and analyzed the preoperative basic clinical data,postoperative perivalvular leakage,the incidence of complications such as permanent pacemaker implantation rate and postoperative cardiac function improvement of the two groups of patients.It was found that the results of TAVR surgery in patients with aortic insufficiency were roughly similar to those in patients with aortic stenosis,it is reasonable to believe that TAVR is a viable treatment option for patients with aortic insufficiency,and that the surgical indication can be expanded appropriately in future treatment.